Left Atrial Appendage (LAA) Closure

Overview

Atrial fibrillation (AF) is a major cause of stroke. This happens because flow through the heart slows down.

When blood is moving slowly, it has a tendency to form clots. These clots form mainly in an out pouching of the heart called the left atrial appendage (LAA). Much like the appendix in the abdomen, the purpose of the LAA in the heart is not clear.

Left Atrial Appendage is seen within the black box.

Do I need Left Atrial Appendage Occlusion?

Warfarin therapy has been the gold standard in reducing stroke risk, by reducing the risk of clot in patients with AF. New drugs are now available that may do away with the need for blood tests to monitor blood thinning, and may well also be safer than warfarin. A recent advance was seen in the PROTECT-AF trial, with the use of a “plug” to seal off the LAA. This plug may well be an alternative to warfarin therapy, especially if there have been problems taking the drug.

What is involved and what are the risks?

You will be given general anaesthetic.  The operation is guided by X-rays from the outside, and by ultrasound pictures from a probe in your throat. A pipe is passed from a needle puncture in the leg to the heart and a wire is passed across the heart, and into the mouth of the appendage.  A stiff tube is passed over the wire and a plug-like device is placed in the mouth of the appendage. The pipes are taken out and the hole in the leg (where the pipes have been) is pressed on to stop the bleeding.

LAA device in place.

The main complications related to this procedure are pericardial effusion (internal bleeding), incomplete LAA closure, and dislodgement of the device. Rarely, blood clot formation on the device will require prolonged oral anticoagulation.

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